COMMENTARIES:
• Addiction as a self-regulation disorder and the role of self-medication. Khantzian E.J., p. 668-669.
• The role of trauma in drug use disorders. Breslau N., p. 669-670.
• From self-medication to intoxication: time for a paradigm shift. Lembke A., p. 670-671.
• Shattered childhoods and the genetics of heroin dependence. Agrawal A., Lynskey M.T., Nelson E.C., p. 671-673.
• The role of psychopathology as motivator for drug dependency - Some moderating remarks. Bergmark A., p. 673-674.

The self-medication hypothesis emphasizes the role of distressing affect as the primary motivator for the compulsive use that leads to substance dependence. The model also postulates that there will be psychopharmacological specificity between symptom presentation and the primary drug of dependence. In this review, the self-medication hypothesis is examined in relation to the development and chronicity of heroin dependence. It is argued that if self-medication has a role in engendering and extending substance dependence, it should be apparent in the use of a drug that carries such overwhelming personal risk. The psychopathology seen among adult users is certainly consistent with the model. More importantly, however, are the extraordinarily high levels of childhood trauma and psychopathology that occur typically well before the initiation of heroin use. In contrast, the postulate of drug specificity appears less supported by the polydrug use patterns typical of heroin users, and does not appear to be a necessary corollary of the model.

Domaine :

Drogues illicites / Illicit drugs

Sous-type de document :

Revue de la littérature / Literature review

Refs biblio. :

103

Affiliation :

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia

ENGLISH :
In the article the growing interest of studies on treatment systems rather than specific treatment modalities is taken as a starting point for a discussion and outlook on how the research agenda of drug treatment research will develop in the near future. The relative absence of research that provides substantial guidance in the search for treatment effects has opened up for studies on larger, "natural" entities, which are examined from composite, and theoretically elaborated, standpoints. The article argues that there is much to be done when it comes to research on treatment from a client's perspective and that a development of that particular path is a necessity for a more profound description and understanding of treatment. The need for theoretical input is emphasized and exemplified with ideas from organizational theory and discussions related to the concept of globalization. Finally the article identifies a need for more attention to some definitional issues that must be addressed in order to empirically develop comparative research on drug treatment systems. (Author's abstract.)

Aim: This paper discusses what type of legitimacy underpins addiction treatment in contemporary western societies. Method: Broad review of the relevant literature. Conclusions: The legitimacy of professional interventions and the future of service provision will depend largely on the relationship between the professional and the lay referral system. These in turn are intertwined with macro-societal changes. The basic categories in this relationship are, on one hand, the idea of evidence-based practice (i.e. the notion of using the most accurate scientific support for the choice of treatment interventions), and on the other hand the consumer perspective, which conceptualizes addiction treatment as an interactive process between the treatment provider and the consumer. The acceptance of addiction treatment depends in most cases on the client who chooses from a whole range of informal and formal problem solutions. To an extent, experts are thus controlled by their lay counterparts and need their consent to operate and succeed. This process is complicated by the trend towards evidence-based practice, which demands transparency and rigorous procedures and carries with it the basis for distrust in expert knowledge by displaying openly that every statement of fact is open to revision, and thus, to a certain extent, characterized by uncertainty. (Author' s abstract)

Domaine :

Drogues illicites / Illicit drugs

Sous-type de document :

Revue de la littérature / Literature review

Refs biblio. :

62

Affiliation :

University of Applied Sciences Bern, School of Social Work (HSA), Institute for Social Planning and Social Management (ISS), PO Box 6564, CH-3012 Bern,
Suisse. Switzerland.